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Multiple Sclerosis l: Introduction

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The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool

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Relationship between brain atrophy and disability in a multi-site multiple sclerosis registry.

Ai-Lan Nguyen^1,2, Dana Horakova³, Eva H Havrdova³

¹Neuroimmunology Centre, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.

BMJ Neurology Open

|July 30, 2025

Summary

Brain atrophy and multiple sclerosis (MS) disability were explored. Whole brain volume (BV) at later MRI associated with EDSS scores, but MRI metrics did not predict disability progression in this treated MS cohort.

Keywords:

MRI MULTIPLE SCLEROSIS

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Area of Science:

Neuroimaging
Neurology
Radiology

Background:

Multiple Sclerosis (MS) is a chronic neurological disease.
Brain atrophy is a key feature in MS progression.
Standardized MRI metrics for predicting MS disability are needed.

Purpose of the Study:

To investigate the association between brain atrophy metrics and disability in multiple sclerosis (MS).
To evaluate the utility of different MRI scanners and protocols in assessing MS progression.
To determine if MRI measures can predict future disability worsening in a real-world clinical setting.

Main Methods:

Retrospective multicentre cohort study of relapse-onset MS patients.
Inclusion criteria: two MRIs 12 months apart and ≥2 Expanded Disability Status Scale (EDSS) scores.
MRI metrics assessed: Percentage Brain Volume Change (PBVC), Percentage Grey Matter Change (PGMC), and lesion volumes. Disability measured by EDSS and 6-month confirmed disability progression (CDP).

Main Results:

Whole brain volume (BV) at later MRI associated with EDSS scores (p<0.001) and rate of EDSS change (p=0.02).
No significant association found between longitudinal PBVC or PGMC and CDP or EDSS (p>0.05).
Cross-sectional BV and grey matter volume (GMV) showed a trend for association with CDP (p=0.06).

Conclusions:

In a highly treated MS cohort, only cross-sectional BV was associated with future EDSS scores.
Current MRI metrics showed limitations in predicting 6-month confirmed disability progression.
Findings underscore the challenges in using MRI to predict MS disability worsening in clinical practice.